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  • Writer's pictureStephen Scherer, Ph.D.
    • 3 min read

Therapy-Assisted Ketamine Treatment for Resistant Depression: An opportunity to ACT

By: Stephen Scherer Ph.D.,

Licensed Clinical Psychologist



Acceptance and Commitment Therapy (ACT) and ketamine treatment are making waves in the mental health field, each offering unique and powerful tools for addressing various psychological challenges. While acting through different mechanisms, the two approaches exhibit surprising synergy when combined, creating a new option for deeper healing and increased treatment success.

This post delves into the exciting potential of integrating ACT with ketamine therapy.


Understanding the ACT & Ketamine:

ACT: Rooted in mindfulness and acceptance principles, ACT empowers individuals to navigate difficult thoughts and emotions without getting entangled in them. It cultivates psychological flexibility, allowing individuals to live in accordance with their values despite internal struggles.


Ketamine: Once primarily known as an anesthetic, ketamine has shown promise in alleviating treatment-resistant depression, among other issues. It works by rapidly modulating the brain's neuroplasticity by acting as an NMDA receptor antagonist, potentially leading to new neural connections and rewriting of others. It can also reduce the urgency of experiential avoidance for highly adverse emotions, providing a window of opportunity for psychotherapy


The Power of a Combined Approach:

The window of enhanced plasticity offered by ketamine provides an excellent opportunity for the integration of ACT, with its emphasis on psychological flexibility and acceptance. Combined, the two can be beneficial in the following ways:


  • Embrace present-moment awareness: Ketamine can heighten present-moment awareness, making mindfulness practices like observing thoughts and feelings more accessible. ACT capitalizes on this by teaching clients to stay present with their experience, fostering acceptance and reducing avoidance.

  • Connect with valued selves: ACT can support clients in identifying and clarifying their core values and life goals, provide a guiding compass during the experience of ketamine's effects.

  • Commit to actions: After identifying what really matters to clients, ACT can empower them to take concrete action steps that are aligned with their values, regardless of their mood state. This maximizes the potential for lasting change to occur during the neuroplastic window.

  • Building self-compassion: Ketamine can sometimes lead to self-judgment or fear around the experience. ACT's emphasis on self-compassion helps clients approach their experiences with kindness and understanding, fostering a more supportive internal environment.

  • Maintain motivation and engagement: As ketamine's effects wear off, clients might struggle to maintain progress. ACT's behavioral activation strategies help individuals identify and engage in activities aligned with their values, and sustain positive momentum.

  • Defuse from unhelpful thoughts and feelings: ACT techniques like mindfulness and defusion can help clients observe and accept high levels of unwanted emotions or thoughts without getting hooked by them and take a step back from what would otherwise be an overwhelming experience.

 

Provider Action Steps

  • Seek to Collaborate: Build relationships with healthcare providers offering ketamine-assisted therapy to facilitate communication and ensure client safety.

  • Educate Yourself: Deepen your understanding of ketamine's effects and potential interactions with ACT interventions.

  • Adapt Your Approach: Tailor your ACT sessions to capitalize on the heightened neuroplasticity window facilitated by ketamine. Offer mindfulness exercises, values exploration, and commitment-building activities during this period.

  • Prepare Clients: Discuss the potential benefits and risks of combining ACT and ketamine, ensuring informed consent and managing expectations.

While promising, the research on the combination of ACT and ketamine is still in its early stages. More information is needed to establish best practices, measure long-term outcomes, and understand potential side-effects for clients. If appropriately combined, these two powerful approaches can work hand-in-hand to improve the lives of countless individuals.

 

*Disclaimer: This blog post is intended for informational purposes only and should not be construed as medical advice. Please consult with a qualified healthcare professional before making any treatment decisions.

 

References:

  • Aust, S., Gärtner, M., Basso, L., Otte, C., Wingenfeld, K., Chae, W. R., Heuser-Collier, I., Regen, F., Cosma, N. C., van Hall, F., Grimm, S., & Bajbouj, M. (2019). Anxiety during ketamine infusions is associated with negative treatment responses in major depressive disorder. European neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 29(4), 529-538. https://doi.org/10.1016/j.euroneuro.2019.02.005


  • Hasler, G. (2019). Combining ketamine with psychotherapy to treat depression: A theoretical review. Neuropsychopharmacology, 44(1), 83-92.


  • Khoevisch, I., De Ronchi, D., & Veronese, M. (2020). Acceptance and commitment therapy and psychedelics: Synergistic potential for treating mental health conditions. Frontiers in Psychology, 11, 2200.



  • Philipp-Muller, A. E., Stephenson, C. J., Moghimi, E., Shirazi, A. H., Milev, R., Vazquez, G., Reshetukha, T., & Alavi, N. (2023). Combining Ketamine and Psychotherapy for the Treatment of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. The Journal of Clinical Psychiatry, 84(2), 45459


 

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